A 73yo woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent
chest infections recently. Choose the single most likely blood film findings?
a. Atypical lymphocytes
b. Excess of mature lymphocytes
c. Plasma cells
d. Multiple immature granulocytes with blast cells
e. Numerous blast cells
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answer: B
atypical lymphocytes: lymphomas
mature lymphocytes: chronic lymphocytic leukemia (HSM and lymphadenopathy common) common: old age
plasma cells: multiple myeloma (HSM and lymphadenopathy rare)
immature granulocytes + blast cells: chronic myeloid leukemia (any age) mostly just spleenomegaly
numerous blast cells: acute myeloid leukemia (mostly old age, 10-15% children) fever common
small blasts: acute lymphoblastic leukemia (75% in children, next peak >40years) meningeal signs common
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